Pulmonary Calcifications in Children on Dialysis

Abstract

Pulmonary calcifications are known to occur in patients with chronic renal failure. Recently, scintigrams with bone-seeking radionuclides have been used to detect subclinical pulmonary calcium deposits. We studied 18 children on maintenance dialysis without evidence of pulmonary calcification on chest X-ray. Four children (22.2%) had a positive technetium 99m hydroxymethylene diphosphate scan (group 1), and 14 children had a negative scan (group 2). Mean serum aluminum levels were 2.68 ± 0.30 μmol/l (mean ± SD) in group 1 as compared to 1.66 ± 0.72 in group 2 (p < 0.01). No significant difference was found between the groups with respect to serum levels of calcium, phosphorus, bicarbonate, magnesium and the calcium-phosphorus product as well as parathyroid hormone and vitamin D levels. The patients with pulmonary calcifications were on dialysis a significantly longer time than those of group 2 (62 ± 15 versus 35.7 ± 23 months; p < 0.01). These data show that pulmonary calcification occurs with high frequency in children undergoing long-term dialysis. They seem to be related to high serum aluminum levels. We propose that pulmonary scintigrams with bone-seeking radionuclides be used routinely for the diagnosis and follow-up of uremic pulmonary calcification.

Magnesium in Chronic Kidney Disease: Challenges and Opportunities

“…The authors suggested that the beneficial effect of Mg on carotid intima-media thickness might be due to the decreased serum PTH level. Furthermore, Mg-containing phosphate binders have been shown to be effective agents for controlling serum phosphorus and hyperparathyroidism in ESRD patients [76,77] .…”

Scintigraphy in the clinical evaluation of disorders of mineral and skeletal metabolism in renal failure

“…These calcifications may be of clinical relevance, as demonstrated in some of the patients with extensive pulmonary calcifications which showed abnormalities in single breath carbon monoxide diffusion capacity (DCO) (Conger et al 1975;Faubert et al 1980). This was not the case, however, in the children studied by Drachman et al (1986). Conger et al (1975) also found significant hypoxia and decreased vital capacity in his patients, but this was not confirmed in two other studies (Faubert et al 1980;Drachman et al 1986).…”

“…This was not the case, however, in the children studied by Drachman et al (1986). Conger et al (1975) also found significant hypoxia and decreased vital capacity in his patients, but this was not confirmed in two other studies (Faubert et al 1980;Drachman et al 1986). …”

“…Uptake of diphosphonates appears to be uncommon in the myocardial region, as it was not reported in the series of patients mentioned above (Sy and Mittal 1975;Conger and Alfrey 1976;Olgaard et al 1976;Velentzas et al 1978;Faubert et al 1980;Drachman et al 1986;Van Diemen-Steenvoorde et al 1986). In a survey of case reports of patients with diffuse uptake in pulmonary calcifications (Choy and Murray 1980), only 5 of the 26 patients studied also showed uptake in the myocardial region, and only 1 of these 5 was a patient on chronic haemodialysis.…”

“…Van Diemen-Steenvoorde et al (1986) further demonstrated increased gastric uptake in 1 of the 16 patients they studied. Gastric uptake was not reported in any of the other series of patients (Sy and Mittal 1975;Conger and Alfrey 1976;Olgaard et al 1976;De Graaf et al 1979a, b;Faubert et al 1980;Drachman et al 1986). False-positive studies can also occur.…”